CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 40 53.000000 2650.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 48.000000 3600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 36.500000 2737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 64.500000 3579.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 16.500000 1237.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 128 240.500000 15303.2000 63.6308
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 84 78.000000 3900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 138 128.250000 6412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 19.750000 987.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 19.000000 950.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 87 62.000000 3100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 38 159.750000 3993.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 193 931.000000 46550.0000 50.0000
INTR-T1013-INTERPRETER 16 62.750000 3067.5000 48.8845
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 575 3278.000000 32780.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 41.000000 2205.4800 53.7922
PHY-97110-PT SESSION BY LICENSED PT 17 46.500000 2393.0400 51.4632
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 153.000000 10351.2000 67.6549
TRAV-TRAVS-Travel by mile 621 60167.00000 26778.5700 0.4451
Subtotal (Total Children Is Unduplicated) 640 65148.00000 143519.5400 2.2030
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Total 65388.500000 158822.7400 2.4289
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Number of Children (Unduplicated) With at Least One Service 656
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Center 05
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 5260 65309.500000 158739.8000 158736.6840
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3 79.000000 82.9400 63.8000
Other 0 0.000000 0.0000 0.0000
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Total 5263 65388.500000 158822.7400 158800.4840